2014 European guideline on the management of syphilis

Abstract

Syphilis is a disease that is relatively easy to detect by appropriate serological tests, however, all laboratory results should be considered together with clinical data and sexual risk anamnesis. Syphilis is also easy to treat with BPG. A major concern about the supply of BPG in many European countries could threaten the efficacy of the policies of eradication of the disease in Europe.

Syphilis iridocyclitis in a patient with type 1 diabetes

“…Although international guidelines for treatment suggest penicillin‐G as the first‐choice drug for the treatment of all stages of syphilis5, we started with ceftriaxone and doxycycline, continuing at home with benzathine penicillin (four intramuscular doses of 2.4 MU each at 1‐week interval). Immediately after the first dose of ceftriaxone and doxycycline, the patient developed a Jarish–Herxheimer reaction (as a result of a massive release of treponemal antigens); however, in the light of such a reaction and in order to prevent a possible worsening of the ocular manifestations, i.v.…”

The role of Point-of-Care testing in the diagnosis of syphilis

“…The European Centre for Disease Prevention and Control (ECDC) [28] and the British Association for Sexual Health and HIV (BASHH) [29] suggest a different approach, meaning that a TT should be used first, followed by a second TT when reactive. Since POCT includes mostly TTs, this recommendation could be adopted everywhere and become universal.…”

Neurosyphilis and the impact of HIV infection

“…38 The range of formal recommendations reflect a lack of consensus as to which patients truly benefit from screening and intervention for potential neurosyphilis, which in turn relates to a dearth of systematic studies in this area. Based on recent studies, and the relatively low-risk of elective lumbar puncture in the controlled setting of an outpatient clinic, it may be reasonable to assess HIV-infected patients with a CSF examination who may be at higher risk of neurosyphilis based on a lower CD4 count range or high serum RPR titres.…”

“…43,[54][55][56][57] The United States CDC, European syphilis guidelines and Canadian Public Health guidelines recommend penicillin desensitisation for penicillin allergic patients in whom ceftriaxone is not an option. 21,37,38 In patients who have improvement, resolution or stabilisation of neurological symptoms and normalisation of CSF abnormalities, treatment for neurosyphilis is deemed successful. The CDC recommends that patients undergo repeat lumbar puncture every 6 months until the CSF WBC normalises.…”

“…As the treatment duration of neurosyphilis is up to 2 weeks, the United States CDC also states that practitioners may consider treating patients with late syphilis with benzathine penicillin, 2.4 million units IM once per week for up to 3 weeks, following treatment for neurosyphilis; 21 the European syphilis guidelines make no such suggestion. 38 In our practices, we continue treatment according to the CDC guidelines. Neurosyphilis with ocular and otologic manifestations is treated identically, although steroids may be used as an adjunctive therapy.…”